HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: o IS-1
RECEIVED
Building Permit Applicatio
Planning and Development Services NOV 14 2U18
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ST. Lucie County, Permitting
Phone: (772)462-1553 Fax: (772)462-1578 Commercial eSl ential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
P;ROP.OSED'I,MPR01/,E EENT LQ4CATIC)N
Address:
Legal Description:
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Property Tax ID#: - 1.2 —70/ (0 7a —�/°�— Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETA[i=ED DESCRIPTItJN OF WORK
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e
CON5,TRUCT!'ON IN
Additional work to a er orme un er this permit—check a appy:
HVAC 11 Gas Tank ❑Gas Piping Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: _Sewer 0Septic Building Height:
OWNER/'LESSEE CONTRACTOR
Name Name:
Address: Company: ( cAX\1_t�Ir�/C-
City: - State. _ Address: Vo 46 �''� ' k_t'
Zip Code: Fax: ff %Z4 3 city: Qt' State:.��
Phone No. l/ Zip Code: Fax:
E-Mail-0i Phone No. —1 161
Fill in fee simple Title Holder on next page(if different E-Mail: Cj C V 0_C.i_
from the-Owner listed above) State or County License: C_&CO b 0 (O C1
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPRLEMENTAL CONSTRUCTION LEEN LAUV INFORMATION:
r _ _
.DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize thepermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements:to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. • end Yo obtain financing, consult with ler r or an attorney before
commencing work o i our N ice of Commencement.
Si ature4see/Con_tr r as Agent for Owner Signatur f-C tra ,License Holder
TATE STATE OF FLORIDA
L(,� /�� COUNTY OF
The forgoing tnstr met as acknowledged before me The for oing instrument was;acknowledged before me
thisr day of A__ 220/�y this��Elay of _ 20A by
game of person making statement Name of person making statement
Personally Known OR Produced Identification, Personally Known OR Produced Identification _
Type of Identification c,� / Type of Identification
Produced /L 1� /b%J Produced fl55P0�1_
1
(Signature of Notary Pu tic-,State of Florida) (Signature of Notary Publi State of Florida
Commission No. ,� Y?� DftENE CHACON Commission DARLENEC CO
MY COMMISSION#GG 023966 =*: :*: MISSlON�3966
*' *- `e= EXPIRES:September 9,2020
EXPIRES:September 9,2020 =+rF oQ
T••...•a`; o' ,.•' ru No Pubiic Undervvriters
i_
0A xmi�li
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17